Welcome to question of the day #194

Eyetools question of the day #194

One of my patients has recently attended eye emergency. He was hitting a metal bolt with a metal hammer and something hit him in his right eye. He has been told by a hospital doctor that he has suffered corneal damage and the vision in that eye will not return to normal levels. What can I do to prevent this from happening to other patients?

Before becoming an eye specialist I worked in construction. I was involved with preparing the ground prior to the construction of buildings and an airport in London, UK. Even then I was amazed at the lack of eye protection worn by many of the site workers. Eye protection was available but there seemed to be a macho reluctance to wear any. Of course, many workers spent hours in local emergency eye departments having all sorts of debris removed from their eyes. Some suffered permanent vision loss. During my work in the Asian subcontinent and the Middle East, I often saw construction workers hitting things without wearing eye protection. I couldn’t tell if this was because of a lack of available eye protection or because of the same macho approach I had seen in London.

One way of trying to avoid this happening to your other patients is to ask, during the history and symptom taking, whether they are ever in a situation where something may hit them in an eye. This is especially important for people with amblyopia or disease in one eye that has already reduced the vision in that eye. You could give examples like, hitting metal with metal, working underneath vehicles where something could fall into an eye, playing golf, playing squash, and working in a dusty, gritty environment.

These patients could be offered wraparound over shields that protect the eyes even if spectacles are being worn or refractive correction lenses made out of polycarbonate or sports goggles.

You could make this type of work a subspecialty of the practice and attract new patients. For a small investment, you could purchase a selection of examples of different types of overshields and sports goggles and become familiar with the advantages and disadvantages of polycarbonate lens material. You could do a great deal of good for your patients, especially those with only one good eye, and at the same time help your practice prosper.